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Published on: September 18, 2013
Fever and granulocytopenia in children with acute lymphoblastic leukemia under induction therapy
H M Meir1, I A Balawi, H M Meer
1Department of Oncology, King Abdulaziz Hospital and Oncology Center, PO Box 31467, Jeddah 21497, Kingdom of Saudi Arabia. hadirmeir@hotmail.com
Insights
Infections are a major risk for children with acute lymphoblastic leukemia (ALL). This study reviewed infectious complications in Saudi children with ALL, finding Gram-positive cocci were the most common pathogens.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Infection is a significant complication in cancer therapy, particularly for acute lymphoblastic leukemia (ALL) patients.
- Prophylactic broad-spectrum antibiotic use has altered the spectrum of causative organisms in cancer-related infections.
- Understanding infectious patterns is crucial for managing pediatric ALL.
Purpose of the Study:
- To retrospectively review the types and sequence of infectious complications in Saudi children undergoing induction therapy for ALL.
- To identify the most common infectious sites and causative microorganisms in this patient population.
- To inform strategies for infection prevention and management in pediatric ALL.
Main Methods:
- Retrospective analysis of 233 febrile episodes in 137 children with ALL receiving induction therapy (modified BFM protocol).
- Evaluation of neutropenia, clinical signs, microbiological data, and mortality.
- Analysis of culture results to identify bacterial pathogens.
Main Results:
- Profound neutropenia occurred in 31% of episodes.
- The respiratory system was the most frequent infection site (17%).
- Gram-positive cocci (54%) were the predominant organisms, followed by Gram-negative bacilli (39%).
- 3% of patients died due to infection-related complications.
Conclusions:
- Regular review of infection types, frequency, severity, and outcomes is essential.
- Epidemiological patterns of infection in pediatric ALL patients require ongoing surveillance.
- This data highlights the need for tailored strategies to combat infections in this vulnerable group.
Objective:
Infection is one of the most serious complications of cancer therapy. The rationale of using broad spectrum antibiotics prophylactically has led to a great change in the causative organisms. The aim of the present study is to review retrospectively the type and sequence of infectious complications among Saudi children with acute lymphoblastic leukemia.
Methods:
A total of 233 febrile episodes were observed in 137 children with acute lymphoblastic leukemia under induction therapy using modified BFM protocol were studied.
Results:
Profound neutropenia (Absolute Neutrophil count < 100/mm3) was encountered in 72 episodes (31%). Clinical signs and symptoms suggestive of infection were evident in 39% of the neutropenic episodes. The respiratory system was the most frequently affected site encountered in 17% of the episodes. Microbiologically documented infection was recorded in 59% (n=137) of the fever and granulocytopenia episodes. In 96 episodes (41%), there was neither clinical nor microbiological evidence of infection fever of unknown origin. Out of the 932 cultures, positive isolates were detected in 346 cultures (37%). Gram positive cocci were the most frequently organisms (54%) followed by gram negative bacilli (39%). In the current study, 7 patients (3%) died because of direct or indirect consequences of infection.
Conclusion:
The current study stresses the importance of frequent reviewing of the type, frequency, severity and outcome of infection complications over years to detect changing epidemiological patterns.
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